Almost everyone agrees that America’s health-care system has the incentives all wrong. Under the fee-for-service system, doctors and hospitals get paid for doing more, even if added tests, operations and procedures have little chance of improving patients’ health. So what happens when someone proposes that we alter the incentives to reward better care, not more care? Well, Rep. Paul Ryan and Republicans found out. No surprise: Democrats slammed them for “ending Medicare as we know it.”

This predictably partisan reaction — preying upon the anxieties of retirees — must depress anyone who cares about the country’s future. It is only a slight exaggeration to say that unless we end Medicare “as we know it,” America “as we know it” will end. Spiraling health spending is the crux of our federal budget problem. In 1965 — the year Congress created Medicare and Medicaid — health spending was 2.6 percent of the budget. In 2010, it was 26.5 percent. The Obama administration estimates it will be 30.3 percent in 2016. By contrast, defense spending is about 20 percent; scientific research and development is 4 percent.

Uncontrolled health spending isn’t simply crowding out other government programs; it’s also dampening overall living standards. Health economists Michael Chernew, Richard Hirth and David Cutler recently reported that higher health costs consumed 35.7 percent of the increase in per capita income from 1999 to 2007. They also project, that under reasonable assumptions, it could absorb half or more of the gain between now and 2083.

Ryan proposes to change that. Beginning in 2022, new (not existing) Medicare beneficiaries would receive a voucher, valued initially at about $8,000. The theory is simple. Suddenly empowered, Medicare beneficiaries would shop for lowest-cost, highest-quality insurance plans providing a required package of benefits. The health-care delivery system would be forced to restructure by reducing costs and improving quality. Doctors, hospitals and clinics would form networks; there would be more “coordination” of care, helped by more investment in information technology; better use of deductibles and co-payments would reduce unnecessary trips to doctors’ offices or clinics.

It’s shock therapy. Would it work? No one knows, but two things are clear.

First, as Medicare goes, so goes the entire health-care system. Medicare is the nation’s largest insurance program, with 48 million recipients and spending last year of $520 billion. About 75 percent of beneficiaries have fee-for-service coverage. If Medicare remains largely fee-for-service, the rest of the system will, too.

Second, few doubt that today’s health-care system has much waste: medical care that does no good; high overhead costs. In a paper, Cutler documented some evidence. In one survey, 20 percent of patients reported that doctors repeated tests because records were unavailable; the health-care sector has twice as many clerical workers as nurses and nine times as many as doctors; care of patients with chronic conditions is often slapdash, so that, for example, only 43 percent of diabetics receive recommended treatment.

Fee-for-service is open-ended reimbursement; the government’s main tool to control Medicare’s costs is to hold down reimbursement rates. Doctors and hospitals respond by ordering more services to offset the rate limits. For all its flaws, say Ryan’s critics, this system beats his. Indeed, the Congressional Budget Office has estimated that in 2022, Ryan’s plan would be more than a third costlier than the status quo, because Medicare’s size makes it more effective at restraining reimbursement rates.

If the CBO is correct, Ryan’s plan fails; beneficiaries’ out-of-pocket costs would roughly double to cover the added expense. But the CBO may be wrong. When a voucher system was adopted for Medicare’s new drug benefit, the CBO overestimated its costs by a third; the Centers for Medicare and Medicaid Services’ overestimate was 42 percent. When fundamental changes are made to a program, the green-eyeshade types can’t easily predict the results. Moreover, as health expert James Capretta notes, “managed care” plans in the Medicare Advantage program in 2010 did not have higher costs than Medicare’s fee-for-service for similar coverage.

Under Ryan’s plan, incentives would shift. Medicare would no longer be an open ATM; the vouchers would limit total spending. Providers would face pressures to do more with less; there would certainly be charges that essential care was being denied. The Obama administration argues that better results can be achieved by modifying incentives within the existing system. Perhaps. But history suggests skepticism. Presidents since Jimmy Carter have made proposals to control spending, with meager results. From 1970 to 2008, Medicare spending per beneficiary increased an average of 9 percent annually.

It’s Ryan’s radicalism vs. President Obama’s tinkering. Which is realistic and which is wishful thinking? This important debate should rise above cheap political rhetoric. Burdened by runaway spending, Medicare “as we know it” is going to end. The only questions are when and on whose terms.

Need fresh ideas to increase client lead generation? Check out this list for ways to find and satisfy existing clients.

There is an idea for everyone from Google Adwords to adding Zest to your media campaign.  Even putting a few of

these ideas put into action can increase your network and boost sales, so what are you waiting for?  Choose a few

things on the list and get started!

So, you’ve established a business and everything is going well, but how do you grow it?  Attracting customers and providing quality goods and services to existing customers is a skill that can be learned.  Elizabeth Wasserman from inc.com details what you as a business owner can do to understand and draw in more clients, in turn increasing your sales. 

By Elizabeth Wasserman

How to better understand your target audience, generate new sales leads, and focusing on getting more revenue from existing clientele.

In a perfect world, you would have an unlimited budget to market your business in order to find new customers and increase sales. You could buy lots of online and offline advertising, run promotions to build traffic in store and online, and launch a proactive public relations campaign to increase your product or brand’s visibility and awareness. But this isn't a perfect world. Realistically, most small businesses and even many mid-sized firms have more great ideas on how to peddle their wares than available resources. 

So where do you start if you are looking for more customers? Learning to generate new sales leads is an essential skill for an entrepreneur. Even if you don't consider yourself a salesperson in the classic sense of the Willy Loman character from Arthur Miller's play Death of a Salesman, you need to understand that the possibilities for finding new customers range from cold calling names from the phone book to buying lists of potential customers to using newer Internet techniques like search engine optimization to drive new business to your website.

The following pages will delve into how to conduct market research to understand your target audience and their needs, how to determine which lead generation techniques are best to broaden your sales horizons, and how to increase sales by following several strategies to sell additional products and/or services to existing customers.

How to Find New Customers and Increase Sales: Understand Your Target Audience

Before you can find new customers and increase sales, you need to understand who your customer is, what value proposition you offer to customers, and what your competition is currently offering in the market and where there are gaps for a new entrant. In other words, you need to do some market research -- whether that means hiring an outside firm to do the legwork or trying to do it yourself. There's an underlying disconnect between your motivation to increase sales and your customer's motivation to solve their problems.

"Attracting more customers is really about listening to their needs, not being a solution looking for a problem," says Paige Arnof-Fenn, founder and CEO of Mavens & Moguls, a strategic-marketing consulting firm whose clients include Fortune 500 companies as well as early stage and emerging businesses.  "There are many existing problems out there that need to be solved that customers are willing to pay for today."

How to Find New Customers and Increase Sales: Find Out Who Your Current Customers Are

In order to develop a marketing plan to reach new customers, you need to better understand who you're already selling to. "If I'm trying to expand sales, I have to find out who my existing customers are. What are their demographics? What do they look like?" says Jerry Osteryoung, director of outreach for the Jim Moran Institute for Global Entrepreneurship at Florida State University. "That means doing market research."

Market research runs the gamut from very simple qualitative research to in-depth quantitative analysis. It can be done very quickly and inexpensively by sending surveys to your existing customers using one of the many online survey tools, such as SurveyMonkey or Zoomerang. You can also get to know the target audience by looking at existing sources of information -- from the U.S. Census Bureau or other government agencies, from trade associations, or from third-party research firms. But depending on the questions you are trying to answer and your research budget, your market research can involve more extensive interviews with customers and qualitative studies on how target customers feel about your business, its products and services.

Certain products and services may appeal to one audience but not to another, so understanding the strengths, weaknesses, opportunities and threats in your target market is critical. You can get to know your customers and segment the market any number of ways including by:

• Demographics -- statistical data on a population including income levels, age, etc.
• Psychographics -- the attitudes and tastes of a certain demographic.
• Ethnographics -- examination of particular cultures.
• Buying habits -- how, what and where customers purchase products and services.

How to Find New Customers and Increase Sales: Defining the Market for Your Product

Use the information about your existing customers to develop a target audience for your business in its drive to win new customers and increase sales. "While there are core customers you are trying to reach, often there are other markets that are also important to address," Arnof-Fenn says. "Make sure you know who the gatekeepers and influencers are; they will affect the decision makers and you will most likely need to sell to them differently than to the end user." For example, parents might be the gatekeepers for products targeted to children or technology managers might hold influence over a company's decision to invest in new software.

Determine which key messages, features and benefits matter to each potential market. Tell these customers how your business can help them solve their problems. "In order to have a customer go to your online shop, you have to find a reason why these customers want to come to you," Osteryoung says. "The value proposition has to be spelled out clearly."

Next, you need to figure out where to reach these customers and whether there should be a marketing or advertising plan that goes along with that outreach.

How to Find New Customers and Increase Sales: Generating Sales Leads

There are a variety of age-old staple techniques and newer tools you can use to find new customers and increase sales. It's best to understand the range of choices you have in order to determine which may best help your business reach new customers. Newspaper readers may not be moved by Internet-based sales techniques. Similarly, business people who are accustomed with hiring only people they know may be better swayed by meeting you at a chamber of commerce meeting than accepting a blind invitation to connect on LinkedIn or Facebook.

"It starts with good people," says Peter Handal, chairman and CEO of Dale Carnegie Training, the sales and leadership training organization. "If you're a one-man shop, it's one thing. But if sales people are really important, you need to hire and motivate good people and you want to give them an upside, such as sales on commission. The motivation is not just money it's also helping them overcome the fear of prospecting."

Here is a rundown on the techniques available:

• Cold calling. This is telemarketing without the call center. It's a blind contact with a potential customer who isn't expecting a pitch. Customer leads can be picked up through scouring newspaper articles or items, lists of leads that are culled by a third-party, or paying attention to people or businesses moving into your turf. "People are always hesitant about cold calling or talking to someone they don't know," says Handal. "We coach people to give themselves a pep talk to get them in the mood. We suggest that they set a goal -- this is how many new people they will talk to this week."
• Networking. This can be done the old-fashioned way, by getting involved in community organizations, such as the chamber of commerce, or attending business functions, such as trade shows. Social functions -- dinner invitations, book clubs, etc. -- can also lead to potential business. "All of those kinds of things are important ways to network to find new customers," Handal says. Networking has also taken a 21st Century twist on the Internet, with the rise in popularity of such websites as LinkedIn, Facebook, and Plaxo. Many businesses find that this type of networking, making contacts through friends or former colleagues, can lead to new customers.
• Develop champions of your products. Use business contacts who have been happy with your products to help generate references and referrals. Once you have sold to them, customers can help you sell to others by offering positive testimonials and leveraging a refer-a-friend campaign created by your business. This technique also employs word-of-mouth marketing. Help customers help you by giving them the ammunition they need to tell your story to others.  "Don't be afraid to ask, 'Is there someone else I can talk to and also help?" Handal says.
• Affiliate marketing. Look at non-competitive products or services that are reaching out to the same audiences to see if there are ways you can collaborate through shared outreach efforts such as newsletters, mailings (online and offline) or co-branding opportunities. You probably can uncover a handful of like-minded products or services that are talking to your customers, Arnof-Fenn says. Suggest to these business owners ways your businesses can support each other. Your customers will see joint efforts as a value-added opportunity to reinforce their choice of brands.
• Leverage your website.  There are all sorts of tools these days through which you can drive potential new customers to your website. Search engine optimization (SEO) -- using keywords and other techniques to make your site appear on the first page of listings on search engines -- has become an art form. There are websites, such as Search Engine Watch, that will keep you updated about SEO techniques. In addition, there are a growing number of paid SEO consultants who can help you use all the tricks and techniques to improve your search results. You can also use a variety of blogs, chat rooms, podcasts, and webinars to generate awareness for your website and company. A website is a dynamic tool not a one-time experience.  The top search engines are constantly updating their algorithms, so you must monitor your website on a regular basis to make sure your keywords are leading customers to you.  Make sure you are keeping your website up to date with fresh content so your customers come back often for more.
• Advertising. Typically businesses are encouraged to spend 3 to 5 percent of their revenue on advertising, but a small business needs to make sure that advertising is effective, Osteryoung says. One way to do this is to ask your customers where they heard about you so that you can measure what is effective. In addition, you also have to carefully pick your markets for advertising to make sure you're reaching your target audience. If you're targeting an older audience, newspaper ads might be the way to go. But if it's Gen X or Y you're after, then you may be better off advertising online or on TV, Osteryoung says. "You've got to define your demographics before you develop your advertising or marketing plan."

How to Find New Customers and Increase Sales: Sell More to Existing Customers

In order to increase sales, many businesses believe the only way is to find new customers, but a number of experts say that this strategy leaves out an obvious potential source of new sales. It's much easier to get an existing customer to buy from you than to convince a new customer to take the plunge. "They're forgetting about low hanging fruit -- their existing customer base," says Osteryoung. "If I want to expand sales, the number one place to go is the existing customer base. They already trust you."

Here's how to increase sales with your existing customer base:

• Bundle products. You can "bundle" a few products or services together for a special price to try to get an existing customer to try some of your other offerings.
• Try the "upsell." Convince your sales staff to go back to existing customers and try to sell those clients related products or services. A common example is a warranty, Osteryoung says. Think of how many times you've purchased electronics and a sales person has tried to sell you on an extended service plan. Customers sometimes take the bait.
• Offer inside information. If a customer is eyeing a product but about to put it back on the shelf, make sure you let them know that the product is going on sale the following week. If you monitor your website's online shopping cart, you may email an existing customer who didn't complete a sale and offer them a discount to complete the purchase.
• Think about customer rewards. Like the airlines have done with frequent fliers, there is no reason a small business can't reward good customers with a loyalty program. Offer a discount on their birthday or for every 10 purchases give them one for free.
• Give free samples. Offering freebies isn't necessarily going to cost you an arm and a leg, but it can increase sales by engendering good feelings among existing customers, convincing them to pass on the sample to a friend or family member, and/or convince them to buy your latest hand cream or ice cream flavor.